Background:

　Endoscopic sinus surgery has become the standard surgical procedure for rhinosinusitis. However, there is no effective classification method for the opening of the sphenoid sinus. We reported the identification of the Onodi cell and classification of the sphenoid sinus using sagittal computed tomography (CT) for sphenoidotomy. We classified the anterior wall of sphenoid sinus into 4 types. Using sagittal CT, the relationships between the lateral side of the anterior wall of the sphenoid sinus and the optic nerve, and between the middle of the anterior wall of the sphenoid sinus and the skull base or pituitary gland were studied. Images were classified as demonstrating Skull base (without the Onodi cell), Optic canal, Sella, or Infra-Sella (all with the Onodi cell) type. This is very easy and useful classification for sphenoidectomy. Based on this identification, the operative procedures were classified into 4 types: olfactory approach (Type 1), ethmoidal approach (Type 2), both approach (Type 3), and median approach (Type 4). We examined the operative procedures in each of the 4 groups, classified on the basis of sagittal CT.

　We can recognize the critical area such as the optic canal and the internal carotid artery around the sphenoid sinus by understanding of this classification and prevent the serious injuries.

　High-invasive surgical treatment for cancer patients is usually avoided in patients undergoing maintenance hemodialysis.

　We reviewed the data of 8 patients with head and neck cancer under maintenance hemodialysis, who underwent reconstructive surgery using a free flap between 2009 and 2017.

　The primary site of the cancer was the oral cavity in 2 cases, oropharynx in 3 cases, hypopharynx in 2 cases, and larynx in 1 case; the mean age of the patients was 60.8 years.

　The mean time from initiation of maintenance hemodialysis to surgery was 4.4 years, and except for 1 case of IgA nephropathy, the underlying kidney disease was secondary to some cardiovascular disease in the remaining 7 cases.

　The free flaps used for reconstruction were anterolateral thigh flaps in 7 cases, and a rectus abdominus musculocutaneous flap in 1 case.

　The average operation time was 440 minutes and the median length of hospital stay was 58 days.

　Dialysis was started on the 2nd postoperative day, and the patients resumed oral intake, on average, 12 days after the surgery.

　There were no severe perioperative complications, such as necrosis of the flap, that necessitated reoperation.

　Out of the 8 cases, 4 died (1 of the underlying head and neck cancer and the remaining 3 of other causes). The 5-year overall survival rate was 40% (95% CI, 5.2%-75%), and the 5-year disease-specific survival rate was 80% (95% CI, 20%-96%).

　Systemic amyloidosis is a rare disease involving multiple organs that is characterized by the deposition of amyloid protein throughout the body. Herein, we report a case of systemic amyloidosis diagnosed in a patient who presented with the chief complaint of submental swelling caused by macroglossia. A 67-year-old woman was referred to us with a swelling of the submental region. Clinical examination also revealed evidence of cardiac insufficiency and stomach wall thickening. Imaging studies revealed that the submental swelling was caused by macroglossia. Laboratory examination revealed high serum levels of IgA, and low levels of IgM and IgG. ECG showed low voltage waves, and echocardiography revealed cardiac hypertrophy. Based on the findings, we suspected amyloidosis, and added amyloid staining of the gastric wall biopsy tissue and immunoelectrophoresis to the diagnostic workup, which led to the diagnosis of systemic AL amyloidosis. Patients with amyloidosis are likely to visit the Department of Otolaryngology with chief complaints pertaining to the head and neck region. Therefore, it is necessary to pay attention to the systemic symptoms and have a high index of suspicion for the possible diagnosis of amyloidosis.

　We encountered a patient with solitary plexiform neurofibroma of the tongue, although neurofibroma is generally seen as a manifestation of neurofibromatosis. We report a case herein, with some bibliographical consideration.

　The patient was an 82-year-old female with no family history of neurofibromatosis, who presented to us with a nodule on the right side of the tongue that she had first noticed a few months before visiting our hospital. The nodule on the right side of the tongue measured a few millimeters in diameter, and had the same appearance and consistency as those of the tongue. With no change of the lesion size or characteristics after a few months of observation, we performed resection. Histopathology of the resected specimen revealed the diagnosis of plexiform neurofibroma. We eventually made the final diagnosis of solitary neurofibroma, when no other manifestations of neurofibromatosis were observed.

　While solitary plexiform neurofibroma of the tongue is very rare, close attention should be paid to patients diagnosed as having this condition, in view of the possibility of malignant transformation of the lesion.

　Lemierre syndrome is a systemic infection that is characterized by systemic septic embolism originating from thrombophlebitis of the internal jugular vein secondary to infection of the throat and larynx area. We recently encountered a case that showed early resolution of the symptoms, because we could make an early diagnosis and promptly institute appropriate treatment; we report the case herein with some review of the literature.

　The patient was a 54-year-old Japanese man from Myanmar. He developed throat pain and fever, for which he took antibiotics, antipyretics and analgesics; however, as the symptoms worsened and swelling of the neck appeared, the patient returned to the emergency department. CT and cervical angiography revealed a left deep neck abscess and thrombosis of the left internal jugular vein, on the basis of which we made the diagnosis of Lemierre syndrome. We performed surgical drainage, and treated the patient with antibiotics, anticoagulant treatment was started on day 4. Thereafter, the patient's symptoms improved quickly, with no complications. The antibiotic administration was completed on day 32, and the anticoagulant treatment on day 52.

　Lemierre syndrome is still a comparatively rarely encountered at present. We have to keep in mind the possibility of this syndrome in patients presenting with throat pain, neck pain and neck swelling, so that serious complications could be prevented.